A monthlong investigation finds plenty of fire to go with the smoke surrounding the university's incredibly vague conflict-of-interest policies.

By

September 9, 2009

Harvard Medical School is exactly the kind of private institution on which the public welfare depends. The research and training it conducts have a ripple effect not only throughout this country but in much of the world. With its unmatched prestige and resources, however, come equivalent responsibilities. If the school allows its faculty to be corrupted by greed and payola, then society suffers as well.

No doubt the easiest, albeit not the only, way to undermine Harvard’s mission would be to invite the pharmaceutical industry to offer secret bribes to its faculty in order to ensure that their research and teaching reflected not their scholarly judgment but the profit motives of these mega-corporations. This may, however, be just what is happening. (It certainly appears that way.) In 2008 Harvard earned an F from the American Medical Student Association for its lax conflict-of-interest standards on accepting Big Pharma cash, while the University of Pennsylvania, Stanford and Columbia won A’s and B’s. And back in March, members of its student body–many of whom were surreptitiously photographed by a representative of the Pfizer Corporation–demonstrated against the school’s administration with the intent of “exposing and curtailing the industry influence in their classrooms and laboratories, as well as in Harvard’s 17 affiliated teaching hospitals and institutes.”

The New York Times‘s Duff Wilson spent more than a month researching the issue and found plenty of fire to go with the smoke. He discovered that roughly “1,600 of 8,900 professors and lecturers have reported to the dean that they or a family member had a financial interest in a business related to their teaching, research or clinical care. The reports show 149 with financial ties to Pfizer and 130 with Merck.” Just one Harvard professor’s disclosure listed forty-seven company affiliations, but the school’s rules do not require specificity regarding speaking or consulting fees, other than meaningless categories such as “more than $30,000,” making it impossible to determine who is buying what. Nor, according to the Times, are there “limits on companies’ making outright gifts to faculty–free meals, tickets, trips or the like.” On an institutional level, $8 million from sleep research companies created three new endowed professorships. Other companies are creating faculty prizes, subsidies and so forth. A first-year student told Wilson, “Before coming here, I had no idea how much influence companies had on medical education. And it’s something that’s purposely meant to be under the table, providing information under the guise of education.”

Together with the revelation by Senator Charles Grassley that a couple of famous faculty members have earned more than $1 million each in unreported fees from companies that stood to benefit from their recommendations, the recent spate of bad publicity spurred the Harvard administration to look into the possibility of healing itself. Medical school dean Jeffrey Flier, who remains an enthusiastic and unapologetic fundraiser from industry sources, and has received such funds for his own research, recently appointed a nineteen-member committee to “re-examine” Harvard’s incredibly vague conflict-of-interest policies.

In the meantime, what did the school decide to do? Again, by all appearances, it chose to muzzle its students. The student handbook was revised to read, “All interactions between students and the media should be coordinated with the Office of the Dean of Students and the Office of Public Affairs. This applies to situations in which students are contacted by the media as well as instances in which students may be seeking publicity about a student-related project or program.” When Wilson reported this policy in the Times, the school immediately backtracked. Without denying that adjustments were at least in part prompted by student remarks regarding Pharma funding and influence, dean of students Nancy Oriol explained, “The wording is problematic, and it doesn’t really capture our intent.” I called the dean because I thought the handbook’s intent was crystal clear. We did not speak, but I did see an e-mail to students following up from Jules Dienstag, dean of medical education, alleging that the purpose of the guideline had been “to inform students who wish to speak with journalists that we can serve as a vital resource.” Dienstag claimed to be particularly concerned about protecting patient confidentiality and other privacy-related issues. But Wilson tells me that “we [still] haven’t got to the bottom of the amount of influence drug companies and other special interests have on medical education or continuing medical education. As we reported, Harvard Medical’s dean wants to increase, not decrease, the school’s connections with industry.”

The Times’s reporting of this story offers one of the strongest arguments available for the importance of preserving the kind of journalism it represents. We all know that democracy relies on reporters to act as watchdogs on government. Most understand that business requires a close eye as well. Bloggers, foundations and displaced reporters are eager to do what they can to fill those respective voids. But what of a wholly private, ostensibly beneficent organization like Harvard Medical School? Though it receives massive government grants, it is not covered by the Freedom of Information Act. Its administration reveals information only as it sees fit. Do you think it will cooperate with some blogger? And consider the expense of a decently paid professional reporter spending more than a month on a single story unlikely to sell a single paper. Who is going to pay for that? Under such circumstances, who is going to think it worth investigating in the first place?